Understanding Microtia & Your Treatment Options
Microtia literally means small ear. Patients with this rare condition have a small, abnormally shaped or absent external ear. Most patients have this condition only on one side (unilateral), however it can occur on both sides (bilateral).
Typically, microtia not only involves the outer ear, but is also associated with conductive hearing loss. Typically, patients have difficulty hearing and determining the direction of sound. This is commonly due to the absence of the ear canal and is called aural atresia.
A patient with microtia and aural atresia in both ears will be significantly hard of hearing and require a hearing aid. Patients with aural atresia typically also have incomplete formation of the small middle ear bones and often lack an eardrum.
Recognized & Trusted By
Finding Hope
Expert Guidance for Microtia & Atresia
Learning that your child has microtia can be an overwhelming moment. Questions about the condition, its impact on daily life, and what the future holds are completely natural — and you don’t have to find the answers alone.
For adults living with microtia, those same questions often carry years of emotional weight. The effect on self-esteem and quality of life is real, but so is the possibility of change.
Dr. Youssef Tahiri and his team are here to help. A globally recognized leader in pediatric plastic, craniofacial, and adult reconstructive surgery, Dr. Tahiri brings both deep expertise and genuine compassion to every family he works with.
- Trusted Worldwide: Over 4,500 microtia patients treated across more than 65 countries.
- Published Authority: Co-author of Modern Microtia Reconstruction: Art, Science, and Clinical Techniques — the definitive textbook on ear reconstruction.
When you work with our team, you can expect more than exceptional surgical care. We take the time to help you truly understand your child’s condition and every treatment option available, so you can move forward with clarity and confidence.
The Condition
Understanding Microtia
Microtia is a congenital condition that causes a child to be born with a small, malformed, or missing ear. For 90 percent of microtia patients, the condition only affects one ear.
Because microtia is so rare, it is rarely detected on prenatal ultrasounds. The condition can also come as a surprise to parents because children with microtia rarely have a family history of irregularity.
Microtia is especially rare in the U.S., where only 1 in every 8,000-10,000 children is born with this condition each year.
Incidents of microtia are higher in other countries, however, particularly in Central and South America, and China sees more instances of microtia than anywhere else in the world.
Dr. Tahiri sees patients from around the world. Their institute is globally recognized, thanks to their innovations and advanced surgery for aesthetic correction and hearing restoration.
Patient Education
Understanding the Four Stages of Microtia
Microtia is typically classified into four stages based on the extent of external ear development. Reviewing these stages provides clarity and helps us determine the most appropriate precision care for every journey.
Stage I is characterized by a small ear with mostly normal external development. Patients with Stage 1 microtia may have a narrowed or missing ear canal.
Stage II is typified by some irregular external development, especially in the top two-thirds of the ear. Stage 2 patients often have a missing or narrowed ear canal.
Stage III is the most common grade of microtia. Patients with this stage of microtia have small, underdeveloped ears with no ear canal.
Stage IV microtia patients have no external ear structure or ear canal.
Genetics & Causes
Is Microtia Genetic?
The root cause of microtia remains largely unknown. However, some experts propose a genetic basis for this congenital condition.
Research suggests that approximately 5% of microtia cases occur when there’s a family history of this condition, with siblings of affected individuals at slightly elevated risk.
However, it’s crucial to note that 95% of children born with microtia have no family history of the condition. For this reason, medical experts aren’t convinced that microtia is a hereditary condition.
A consultation with a geneticist is recommended to get a more definitive understanding of the genetic factors involved.
Genetic evaluation can help determine if microtia is linked to a hereditary condition and serve as a guide for subsequent medical management.
Living with Microtia
Is Microtia a Disability?
The Centers for Disease Control and Prevention (CDC) defines a “disability” as any condition that makes it difficult for an individual to perform certain activities or interact with the world.
While microtia itself doesn’t necessarily constitute a disability, associated hearing loss often does.
Hearing loss may be grounds for eligibility for various disability benefits depending on its degree of impact on an individual’s life.
For this reason, comprehensive support is essential, which can include the following:
- Seeking professional guidance from an otolaryngology (ear, nose, and throat expert) or audiologist
- Offering psychological and emotional support
- Exploring treatment options to enhance quality of life, such as surgical reconstruction or bone conduction hearing aids
Prevalence & Patterns
How Common Is Microtia?
Like many congenital disorders, microtia is relatively, affecting approximately one in 8,000 to 10,000 newborns.
Males are diagnosed with microtia twice as frequently as females, and the condition is more prevalent in certain ethnic groups, including Asians, Pacific Islanders, and Hispanics.
In most cases, microtia affects only one ear, usually the right ear. However, occurrences that impact both ears (bilateral microtia) have been observed in around 20% of cases.
Recognizing Microtia
What Are the Symptoms of Microtia?
The physical manifestations of microtia vary significantly among individuals. Symptoms can range from a smaller-than-normal ear to the absence of the external ear (anotia).
Due to this variability, a precise diagnosis is critical for determining the most suitable course of treatment.
Depending on the condition’s severity, medical intervention may involve prostheses or surgical procedures like cartilage grafts.
Expert Insights
Microtia: What to Expect When a Child Is Born with One Ear
Understanding the potential implications of microtia is essential for individuals and families affected by this congenital condition. This knowledge empowers informed decision-making regarding treatment and management strategies.
Dr. Tahiri, mid check-in
A note from Dr. Tahiri & the care team
We know these questions come from a personal place. Below is what we walk almost every family through in that first conversation — the same explanations, in the same words — so you have them before you ever step into the room.
Effects of Microtia
Children with all stages of microtia may face harassment and bullying, particularly at school.
However, the most obvious difficulty for microtia patients is the decreased hearing ability resulting from a narrowed or missing ear canal.
Although patients can still hear out of the unaffected ear, diminished hearing can make it difficult to detect individual sounds in noisy environments.
When a patient can only hear on one side, the brain has difficulty filtering out background noise and determining which direction noises are coming from.
This diminished hearing can cause trouble for patients, especially in school and social settings. In some cases, it can also lead to speech impairment.
What Other Medical Problems Are Associated With Microtia?
Approximately 10-20% of cases occur alongside other anomalies such hemifacial microsomia, Goldenhar syndrome, and Treacher Collins syndrome.
These syndromes affects the facial structure, usually the ear and jaw. However, the eye, cheek, and neck may also be affected. Moreover some patients may present with empty eye sockets, facial paralysis, and missing jawbones.
Other possible anomalies associated with microtia include facial nerve weakness, cleft lip or palate, and, in rarer instances, cardiac and urological abnormalities.
Still have questions of your own? That's normal — and we're glad to answer them.
Get In Touch TodayGetting the Diagnosis
How is Microtia Diagnosed?
Microtia is generally diagnosed at birth due to the visible abnormality of the outer ear. While prenatal ultrasounds can sometimes indicate potential issues, a definitive diagnosis is usually made after delivery.
Healthcare providers often examine the internal ear structures using CT (computed tomography) scans to assess the condition’s extent and identify any potential underlying problems.
Prenatal
Ultrasound Indicators
Can sometimes flag potential issues before delivery, though findings at this stage are not conclusive.
At Birth
Visible Diagnosis
A definitive diagnosis is typically made after delivery, based on the visible abnormality of the outer ear.
~2.5 Years
Temporal Bone CT Scan
Detailed imaging of the ear and middle ear once bone structures are large enough to evaluate accurately.
When to Get a CT Scan
Why timing matters
A temporal bone CT scan provides detailed images of the ear and middle ear specifically, which can be valuable in assessing middle ear bone quality and ruling out a cholesteatoma in some cases.
It’s typically discouraged until the child is old enough — due to the risks of radiation exposure and the need for anesthesia — and until the middle ear bones are large enough to be evaluated accurately.
What the scan evaluates
- Middle ear bone quality and structure
- Presence of cholesteatoma, ruled out where relevant
- Overall extent of the condition and any underlying anomalies
Advanced Microtia Care
Life-Changing, Cost-Effective Microtia Treatment for Children and Adults Born With One Ear
Fortunately, Dr. Tahiri offers advanced, cost-effective treatment for both the cosmetic problems and the hearing difficulties associated with microtia.
Their innovative porous polyethylene ear (PPE) implants, which include MEDPOR™ and the latest iteration SUPOR™, allow them to create an external ear structure using a child’s own tissues—a technique that offers a number of benefits.
These implants use high-density porous biomaterial that can match the shape and projection of a normal ear. They also eliminate the need for ear pinning surgery, reducing the number of surgical stages.
Dr. Tahiri also works with an otologist to enhance hearing and, if possible, create a new ear canal to more fully restore this sense.
Contact Dr. Tahiri to learn more about microtia and their renowned treatment options.
The Treatment Pathway
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Evaluation
A full assessment of ear structure and hearing to determine candidacy and define the treatment plan.
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Treatment
PPE implant reconstruction (MEDPOR™ / SUPOR™) using the patient’s own tissue — no ear-pinning stage required.
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After Care
Ongoing follow-up with Dr. Tahiri’s team, coordinated with an otologist where hearing restoration applies.
Outcomes That Matter
See the Results of Microtia Reconstruction
Every case is different, but the goal is the same: a natural-looking ear and improved hearing, achieved in a single outpatient procedure.
Testimonials
What our Patients Say About Us
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We truly cannot say enough wonderful things about Dr. Tahiri and his entire team. From our very first consultation through surgery and recovery, we have felt incredibly cared for, supported, and confident that our son was in the best possible hands.
Choosing a surgeon for our child was one of the biggest and most emotional decisions we have ever had to make. Dr. Tahiri immediately gave us a sense of trust and reassurance that is hard to put into words. His expertise, precision, patience, and genuine compassion for our son made such a difference throughout this entire journey.
What makes Dr. Tahiri truly exceptional is that he doesn’t just see a patient — he sees the child and the family behind the surgery. He took the time to answer every question, explain everything thoroughly, and make us feel comfortable every step of the way. His attention to detail and commitment to achieving the best possible outcome are evident in everything he does.
And his team is absolutely incredible. Every person we interacted with was kind, compassionate, responsive, and professional. During what could have been an incredibly overwhelming experience, they made us feel supported and never alone.
We are so grateful we found Dr. Tahiri. He has given our son something incredibly special, and we will forever be thankful for the care, skill, and heart he and his team have shown our family.
If you are considering Dr. Tahiri, especially for your child, we wholeheartedly recommend him. We feel incredibly lucky that he is the surgeon who cared for our son. Truly an exceptional doctor and an exceptional team.
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We would like to express our heartfelt gratitude to Dr. Tahiri for everything he has done for our son. He performed our son’s ear reconstruction and cochlear implant surgery with exceptional skill and professionalism.
From our very first conversation with him, we were impressed by his professionalism, compassion, and the confidence he inspired in us. At the time, we did not know much about our son’s condition, microtia, but Dr. Tahiri patiently explained everything, guided us through every step of the process, and helped us understand all of the available options.
We traveled all the way from Romania to place our trust in his hands, and from the very beginning, he assured us that our son was in good hands and that he would care for him as if he were his own child. Those words gave us comfort, hope, and peace of mind during a very important and emotional time for our family. Throughout this journey, he proved through his actions that he truly meant every word.
He treated us with kindness, patience, and respect, and was by our side throughout the surgery and recovery process. Even after the operation, he was always available to answer our questions promptly and explain everything with remarkable calmness and care. His dedication, commitment, and genuine concern for his patients far exceeded our expectations.
We are deeply grateful for everything he has done for our son and our family. We would also like to thank the entire team and the clinic where these life-changing miracles happen. We were welcomed with warmth, professionalism, and outstanding care every step of the way, and our experience was exceptional thanks to everyone involved.
We wholeheartedly recommend Dr. Tahiri and his team to any family seeking the highest level of medical care. He is not only an extraordinary surgeon but also an exceptional human being who treats his patients with compassion, respect, and dedication.
Matei P. and his parents ❤️
⭐⭐⭐⭐⭐
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I cannot say enough wonderful things about Dr. Tahiri and his entire team. We traveled to Los Angeles from Texas for Haiden’s surgery, and from the very beginning, we felt like we were in caring and capable hands.
Dr. Tahiri was professional, compassionate, patient, and truly took the time to make sure we understood everything. He went above and beyond to make sure Haiden received the best possible care. Throughout the surgery and recovery, the communication and support from Dr. Tahiri and his team were amazing.
Haiden did incredibly well, and we are so grateful for the results and the care he received. This experience meant so much to our family, and we could not have asked for a better surgeon or team.
Thank you, Dr. Tahiri, for your dedication, kindness, and for helping Haiden feel confident and giving him such a positive experience. We will forever be grateful!
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We had a wonderful experience with Dr. Tahiri and his staff! They worked very hard for us with insurance obstacles. We love the results!
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If you’re considering surgery with Dr. Tahiri and haven’t made up your mind yet, I would suggest that you go ahead and make that leap!
We met Dr. Tahiri at a conference in Dallas for our son’s microtia and it was a wonderful experience from beginning to end. From the on-site consultation, the insurance pre-approval process, the surgery, and follow-up appointments, we couldn’t have asked for a better experience. There was always an open line of communication with his office and everything is explained thoroughly every step of the way. My son’s surgery was completed just over one month ago and we are more than satisfied with the results so far and the overall experience.
If I could, I would give this rating 10 stars!
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Our 7-year-old son, Marcel, had surgery. All communication with Dr. Y. Tahiri and his team was very easy and responsive. The staff on site were very caring. Dr. Y. Tahiri skillfully and tactfully guided our son through the operating room, filling it with laughter and joy. Our son still remembers it fondly. The post-operative follow-up was always very responsive. Explanations were simple and clear. A huge THANK YOU to Dr. Y. Tahiri and his team!
Sorry for my english. I speak french.
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We had such a wonderful experience with my son’s surgery. From the moment we arrived, Dr. Tahiri and his the entire staff was kind, knowledgeable, and professional. They took the time to answer all of our questions and made us feel comfortable and confident throughout the entire process. The care and compassion they showed meant so much to our family. The surgical team did an amazing job, and we are incredibly grateful for the excellent care my son received. Thank you to everyone who helped make what could have been a stressful experience such a positive one. We highly recommend this team!
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After researching the best options for our 13-year-old son’s ear reconstruction, we found Dr. Tahiri, and we are so happy we waited! His work was truly remarkable, and he was such a pleasure to work with. Our son looked forward to every visit just so he could talk sports with the doctor.
The office staff was incredible. They worked tirelessly to get the surgery approved by our insurance, even spending an entire day dealing with the insurance company to ensure the procedure happened as scheduled. They communicated transparently with us the whole time, leaving us completely confident that we were in good hands. Hands down, don’t hesitate to trust Dr. Tahiri with your microtia surgery!
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Dr. Tahiri is truly an artist. Beyond being an exceptional surgeon, his compassion and empathy never go unnoticed. His entire team is professional, kind, and incredibly supportive.
We are beyond grateful for the outstanding care and such a wonderful experience. Thank you all!
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Dr. Tahiri performed microtia ear reconstruction surgery on my 13-year-old son and we could not be happier with our experience from start to finish. I’m convinced Dr. Tahiri is the best in the world at this unique and complex procedure and we are thrilled with the results. Absolutely incredible work!
Outside of the amazing result, I also appreciated how kind, gentle, and friendly Dr. Tahiri was throughout the whole process. His staff, facility, and communication were also top notch throughout the entire process. HIGHLY recommend!
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A very professional team, everything was well-organized and smooth, and we received answers to all our questions at any time. Dr. Tahiri is very competent and compassionate, always attentive, and provides parents with thorough explanations. He operated on our son (external ear reconstruction), and the result is perfect. We are very satisfied and grateful to him for his kindness, compassion, and exceptional care.
Thank you so much for everything!
Best of luck!
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There are truly not enough words to express how grateful our family is to Dr. Tahiri and his entire team. After years of researching options for our 8 year old son, who was born with bilateral microtia, we knew this was one of the biggest decisions we would ever make as parents. From our very first consultation, Dr. Tahiri took the time to answer every question, explain the entire process, and gave us complete confidence that our son was in the best hands. We traveled from Kansas to California for surgery, and despite unexpected flight delays that caused us to arrive much later than planned for our post-op appointments, Dr. Tahiri and his team graciously accommodated us without hesitation.
We are so grateful that this was only the beginning of our son’s journey. We look forward to returning for his second reconstruction procedure, hopefully before the end of this year. We know he will continue to be in the best hands with Dr. Tahiri and his team.
Getting the Diagnosis
Hearing Considerations
Understanding the relationship between microtia and hearing loss is crucial for early intervention and optimal development.
This section will explore hearing assessment, treatment options, and the importance of a comprehensive approach involving healthcare professionals.
Background
Hearing loss associated with CFM has been well described in individuals with microtia and EAC atresia.
Patients with microtia and malformed ears are typically diagnosed at birth and should undergo audiological testing.
Hearing loss in these patients is typically conductive in nature due to external ear abnormalities, aural atresia and Eustachian tube dysfunction.
Sensorineural hearing loss is less common but may also be present in individuals with CFM due to inner ear anomalies seen in these patients.
Innovative OSIA
Advanced Bone Anchored Hearing Aid Solutions
BAHA stands for Bone Anchoring Hearing Aid. It is a surgically implantable system for the treatment of hearing loss. It has two parts:
- A sound processor
- A magnetic titanium implant: sets up vibrations within the skull and inner ear
An OSIA implant (latest version of the BAHA) enhances natural bone transmission as a pathway for sound to travel to the inner ear, bypassing the external auditory canal and middle ear.
An OSIA guarantees hearing in patient with microtia and conductive hearing loss.
An OSIA can easily be placed at the time of microtia reconstruction. It is placed using the same incision we use for ear reconstruction; thus, no new incisions are made. Moreover, we use the latest form of OSIA which works with a magnet and has no external screw coming out of the scalp.
The advantages of having a OSIA placed at the same time as the reconstruction include:
- No new incisions are made
- The patient does not have to go through anesthesia twice
- We have a lot of experience with placing OSIA
- Since the surgical site is already exposed, the OSIA placement is fast and is done very safely
- No screw comes out of the scalp with the new magnetic OSIA
Otologic & Reconstructive Care
Addressing Hearing Loss
The Otology & Atresia Repair Approach
Microtia is frequently accompanied by aural atresia — the congenital absence or stenosis of the ear canal, with variable middle ear anomalies — which causes significant conductive hearing loss.
Diagnosis and treatment are coordinated between the otologist managing hearing outcomes and the reconstructive surgeon responsible for the outer ear — a partnership that shapes every sequencing decision below.
Why Hearing Loss Is Often Missed
Children with unilateral microtia typically seem to develop normally, and parents usually don't notice a significant difference between them and their siblings without microtia. This is why unilateral hearing loss is often undertreated by otolaryngologists — and usually ignored altogether by plastic surgeons focused on treating the microtia itself.
However, as children get older and communication becomes more sophisticated, hearing issues become more obvious. Sound localization and comprehension, especially in noisy environments, become more difficult. Patients with microtia tend to turn their unaffected ear toward a sound source, because the head itself casts a sound shadow that reduces comprehension in the unturned normal ear.
Once a child is 2.5 years of age, a CT scan of the temporal bones can allow an otologist to determine if an atresia patient is a possible candidate for a canaloplasty — provided the otologist reviews the actual scan, not just the radiologist's report.
Clinical note — the Jahrsdorfer 10-point grading scale is used to predict surgical candidacy from key features seen on the CT scan, and treatment is coordinated with the surgeon responsible for the outer ear.
Diagnostic Criteria
How Repair Sequencing Is Determined
Repair After Reconstruction
The Microtia Institute Advantage
If a patient is not a candidate for atresia repair and a functional canal, a faux canal can be created at the time of microtia reconstruction — preserving a natural result while hearing options continue to be evaluated.
Restoring Hearing
Goals & Techniques of Atresia Repair
One option for improving hearing is surgical correction of the anatomical malformation. Atresiaplasty was first described by Thomson in 1843. His technique has been modified and improved over the past 175 years.
The degree of hearing improvement obtained with atresiaplasty is associated with higher Jahrsdorfer scores.
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Selecting the Right Candidates
Patients with craniofacial syndromes, such as Treacher-Collins or craniofacial microsomia, are often poor surgical candidates due to poorly developed middle ear structures reflected in lower Jahrsdorfer scores.
Selection of appropriate surgical candidates for atresiaplasty and meticulous surgical technique is essential to achieving optimal patient outcomes.
For patients who are favorable candidates for atresiaplasty based on hearing and radiographic assessments, the goals of atresiaplasty, expected outcomes, and anticipated postoperative care should be discussed.
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The Goals of Atresiaplasty
The main goals of atresiaplasty are to create a skin-lined ear canal and a mobile tympanic membrane coupled to a mobile ossicular chain.
Hearing may improve in cases of favorable anatomy. Post-operatively, patients with a patent ear canal and a well-defined postauricular sulcus can potentially be fit with ear level amplification.
Patients who undergo atresiaplasty will typically require ongoing otologic management to clean the ear canal.
Patients and parents need to consider their options for hearing management in the context of their preferences for microtia management.
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Sequencing With Ear Reconstruction
One advantage of Dr. Tahiri’s PPE implant technique is that Atresia reconstruction can be performed before the ear reconstruction or at the same time as the ear reconstruction.
When an atresiaplasty is performed at the same time as the ear reconstruction, it is called a Combined Atresia Microtia (CAM reconstruction), and our team has the most experience in the world.
When an atresiaplasty is performed at the same time as the ear reconstruction, it is called a Combined Atresia Microtia (CAM reconstruction), and our team has the most experience in the world.
CAM Reconstruction · IMI
Next Steps
Discuss Your Candidacy for Atresia Repair
Every atresiaplasty and CAM reconstruction plan begins with a hearing and radiographic assessment, coordinated between your otologist and Dr. Tahiri's reconstructive team.
Nonsurgical Options
When Are Ear Prosthetics Right for You?
Ear prosthetics offer a nonsurgical alternative or temporary solution for individuals with microtia.
These artificial ears, usually crafted from silicone, are designed to closely mimic the appearance of an ear, including the earlobe. Attachment methods include adhesives or magnetic implants.
While ear prosthetics provide an aesthetic benefit, they require ongoing maintenance. In other words, they may not be a suitable option for all individuals with microtia, especially children.
Advanced PPE Technique
Why One Surgery Makes All the Difference
Traditional ear reconstruction uses cartilage harvested from the patient’s ribs to build a new ear framework — a process that requires multiple surgeries spread over several years, two surgical sites, and a lengthy recovery for each procedure. While it is an established approach, the road is long for both children and their families.
Dr. Tahiri’s preferred technique — Porous Polyethylene Ear Reconstruction (PPE/MEDPOR™/SUPOR™) — achieves the same goal in a single outpatient procedure. A biocompatible framework is placed and covered using a small skin graft from the back of the scalp, leaving little to no visible scarring. One surgery. One recovery. Results that last a lifetime.
The ideal age for the procedure is typically between 3.5 and 5 years old — right before kindergarten — early enough to give your child the confidence they deserve, while ensuring the best possible outcome.
Your Questions Answered
Frequently Asked Questions
Did I do something during pregnancy that caused the Microtia?
Microtia is found in children at birth and is usually an isolated condition. As of today, no real causes of Microtia (other than genetic syndromes involving approximately 5%) have been identified.
In some children, microtia occurs along with other facial abnormalities, such as hemifacial microsomia, which involves the underdevelopment of one side of the face, including the ear. In very rare cases, hemifacial microsomia can occur on both sides of the face at once.
Mothers often ask if they did anything during pregnancy that caused microtia. To date and to our knowledge, microtia is not caused by something that the mother did during pregnancy. So, it is important for parents not to feel guilty. Also, it is important to remember that through surgical advances, microtia can be successfully treated via a single procedure in the outpatient setting.
At what age can my child undergo microtia repair? Is it possible to pursue treatment earlier?
The ideal age for the procedure is typically between 3.5 and 5 years old — right before kindergarten — early enough to give your child the confidence they deserve, while ensuring the best possible outcome.
Ultimately, the best decision must be made in consultation with a qualified healthcare provider.
Contact Dr. Tahiri to determine the optimal timing for PPE implants and other microtia repair options.
It seems that ear reconstruction is a cosmetic procedure; why would I put my child through surgery?
As far as I am concerned, the definition of a cosmetic procedure is improving something that is normal. The ear does not only have a cosmetic function but has also a functional aspect.
Reconstructing an ear helps:
- Restoring facial balance
- Improve hearing with either a BAHA or atrasiaplasty
- Helps with psychosocial integration as the patient grows older
- Makes wearing glasses easier
- If done before school age (5 years old), it can prevent harassment and bullying at school
The Microtic ear was not picked up during my ultrasound. Why?
Various anomalies can be detected by the ultrasound technician. Ultrasound technicians often focus on major organs, and external ears are not routinely checked during an ultrasound.
It may be easier to detect microtic ears with new high-definition 3D ultrasounds.
Why should I choose PPE implants for my child’s ear reconstruction instead of rib cartilage?
The traditional method of ear reconstruction has utilized an ear framework made from rib cartilage. Refinements of the cartilage procedure over the years have reduced the number of needed surgical stages.
However, the amount of required harvested cartilage has increased, pushing back the age of reconstruction until 10 years of age or older.
Reconstruction at an older age, and its usual multiple stages, have made microtia reconstruction with autologous cartilage a more arduous physical and psychological endeavor for both children and their parents.
If the final cosmetic result of the constructed ear is not ideal, the entire reconstructive journey can be disappointing.
The use of an alloplastic framework covered by a thin temporoparietal fascia flap offers several advantages over the traditional method of cartilage reconstruction.
Since ears reach 85% of adult size by 3.5 years, ear reconstruction can be performed at a younger age since the need for sufficient costal cartilage is not a factor.
Other advantages of a fascia-covered alloplastic framework over the traditional rib cartilage technique include minimal patient discomfort, a single outpatient procedure, and better ear definition and projection.
At what age should my child have a CT scan and what type of CT scan should be done?
In order to evaluate a child for this life-improving intervention, it has become necessary to perform CT scans of the temporal bone at a much earlier age than previously. Scans at 2.5 years are recommended. The CT scan will allow us to determine if your child is a candidate for Atresia repair, but also allow us to rule out the presence of a Cholesteatoma.
Scan parameters are those used for standard temporal bone studies (1 mm cuts or less with bone windows, usually in a manipulable voxel format without contrast).
How long is the surgery?
The surgery takes approximately 5 hours. Prior to starting the surgery, there is a preparation phase lasting approximately 1 hour. During this phase, anesthesia is being administered, we prepare the head, braid the hair if necessary, plan the surgery, make the surgical markings and prepare you or your child for the procedure.
Is the surgery painful?
Although it is a long surgery and it could seem painful, it is actually not. Patients tolerate it very well. It is done as an outpatient procedure and often, patients require only some minimal pain medications for the first 2 days after surgery. The surgery mostly involves skin and soft tissues. It does not involve muscle or bone and thus, the pain is relatively minimal.
Does the body react to the Polyethylene implant?
No. PPE implants (and SUPOR™) are made of porous high-density biomaterial. This is a completely inert material and will not be rejected by the body.
Are there different types of implants?
Indeed, over the years various implants came on the market. MEDPOR™, OMNIPORE™ and SUPOR™ are the 3 most commonly used implants over time. These implants have been refined over the years to provide the best reconstruction. 3D designed SUPOR™ implants are the ones we now use exclusively.
Where is the surgery performed?
Since this surgery is performed as an outpatient procedure, it is often performed at a surgical center specialized in microtia reconstruction.
Those surgical centers are very experienced with treating patients with microtia and their care is second to none. If the patient has a genetic syndrome such as Treacher Collins Syndrome or other significant comorbidities such as cardiac or pulmonary problems, the surgery is performed at the Cedars Sinai Main Hospital.
What is the recovery period?
Patients are usually back to normal after the 2nd day after surgery. As long as the patient keeps the head dry while the mold is in place and avoids contact sports, there are no activity limitations. Often, our patients come from all over the world and stay for a few weeks in Los Angeles. They end up going roller blading by the beach, they go to the zoo, museums and take part of a lot of outdoor activities.
What is the post-operative care?
The first post-operative appointment occurs at post-op day #2 or #3. The absorptive dressing is removed during this appointment. If fluid is noticed beneath the scalp at that time, it can be easily drained percutaneously with a butterfly needle. The silicone ear splint is left in place for a total of two weeks post-operatively. During that period, the head should be kept dry and the patient should not sleep on the side of surgery to avoid pressure on the reconstructed ear.
For young children, parents should sleep with the child to make sure they do not inadvertently turn and sleep on the operated side.
At two weeks post-operatively, the silicone ear mold is removed and the ear and head are washed with shampoo in the office. Parents are shown how to wash it gently with their fingers on a daily basis. A new silicone ear mold is made for the patient to use at night for the following four months. A light coating of ointment is applied to the ear before applying the ear mold for the next week.
The third post-operative visit occurs after three weeks. Washing can now be done with a gauze pad to encourage removal of the dissolving chromic sutures. Parents are taught how to make the silicone ear mold, which will be worn every night for the following four months (parents are provided with the silicone mold packets). This helps to protect the ear, but more importantly, it helps to maintain the projection of the ear.
A fourth visit around week 4 ensures healing is on track as well. At that point, all sutures are removed. You’ll again be shown how to make replacement ear molds to continue nightly wear over the four-month period.
Who will be the anesthesiologist?
Either at the surgery center or at the main hospital, we work closely with the same group of board-certified pediatric anesthesiologists who are part of the Cedars Sinai Anesthesia Group. Those pediatric anesthesiologists are very experienced and very comfortable treating patients with microtia. We work with them very regularly and they are very familiar with the SUPOR™ ear reconstruction procedure.
What are the most common complications?
Complications most often occur within the first few weeks of surgery. They are rare however. The most common complication would be a small area of exposure of the implant. This means that the tissues in a small area did not survive and the implant is exposed. The rate of this complication is less than 4%. This complication is treated via small revision surgery aimed at covering the implant.
Other complications are rare and include infection, implant fracture and implant migration. Those complications are very rare and their rate is less than 1%.
Moreover, to maintain an adequate posterior sulcus, it is important to wear the silicone mold at night for the first 4 months. We have seen patients who have lost some ear projection because they were not compliant with wearing the mold at night in the first 4 months post-operatively.
What are the post-operative limitations?
Ideally, the patient should limit sports for the first few weeks following SUPOR™ ear reconstruction (4-6 weeks). Following that period, the patient is free to resume his/her regular activities, while wearing normal sport-specific protection.
If my child had previously a cartilage ear reconstruction for which a TPF flap was used, can a SUPOR™ ear reconstruction still be performed?
This is a very good question. In the rare circumstances that a TPF flap is not available (if it was harvested to cover a rib cartilage ear, or if the TPF vessels were injured from a prior surgery or if a SUPOR™ reconstruction was performed and failed), then an occipital fascia flap can be used to perform a SUPOR™ ear reconstruction. This occipital fascia flap is harvested from the back of the head and is used to cover the implant.
Thus, if a TPF flap is not available; it is still possible to perform a SUPOR™ ear reconstruction.
What are the disadvantages of the MEDPOR™, SUPOR™, or OMNIPORE™ ear reconstruction?
The main disadvantage of PPE implants is that they’re not flexible and do not bend like a normal ear. This is seen no matter what implant you use (MEDPOR™, OMNIPORE™, or SUPOR™).
One has to keep in mind that rib cartilage ear reconstruction does not bend either.
The other disadvantage of the PPE implant ear reconstruction is that if it is not secured properly, the ear can descend slightly from its original position (2-5mm). To prevent that, we used a soft tissue leash to suspend the ear at the appropriate position.
Dr. Tahiri specializes in microtia surgery for children. Patients from all over the USA and the world visit his Beverly Hills office to discuss microtia and surgical treatment.
Is there a cure for microtia?
While there is no definitive cure for microtia, meaning it cannot be completely reversed, medical intervention can lead to significant improvements.
Various treatment options exist to correct the physical aspects of microtia. For instance, plastic surgery via PPE implants can improve the appearance of an affected ear.
At the same time, surgical interventions, such as ear canal reconstruction and bone-anchored hearing aids (BAHAs), can enhance hearing and improve the overall quality of life for individuals with microtia.
Is microtia preventable?
Despite ongoing research, there’s no known way to prevent microtia, as the exact cause remains unidentified.
However, certain lifestyle factors can potentially influence the risk.
Avoiding excessive coffee and alcohol consumption and the use of specific medications, such as retinoic acids like Accutane (isotretinoin)—a drug to treat severe acne—during pregnancy is recommended as a precautionary measure.
When should I see my healthcare provider?
Parents should consult a healthcare provider immediately if they suspect their child may have microtia.
Early diagnosis enables prompt development of a comprehensive treatment plan, which, depending on the severity, can include aesthetic correction and hearing restoration.
When can my child go back to regular activities?
The timeline for resuming regular activities after microtia surgery hinges on the specific procedures performed and the child’s overall recovery.
However, we recommend that the patient limit strenuous activity, such as sports, for four to six weeks following the PPE implant procedure.
Fortunately, Dr. Youssef Tahiri and his medical team will facilitate post-operative care, including providing guidelines on when it’s safe for a child to resume regular activities.
Do people with microtia have health complications?
Aside from the typical hearing loss, some individuals with microtia experience health complications, such as:
- Hemifacial microsomia (Goldenhar syndrome)
- Facial nerve issues
- Cleft lip and palate
- Cardiac problems
- Urological issues
However, it’s essential to note that microtia is a condition with varying severity. With early medical intervention, most individuals with microtia can expect to enjoy good overall health.
What questions should I ask my child’s physician?
A diagnosis of microtia can understandably raise many questions. While the Los Angeles Ear and Craniofacial Center team will happily address all concerns, parents are encouraged to proactively gather information to effectively care for their child.
Critical questions to ask the child’s physician include the following:
- “Are there any associated health conditions that may accompany microtia?”
- “How will microtia affect my child’s hearing?”
- “What treatment options are available, and what are the potential benefits and risks of each?”
- “When is the best time to consider surgery?”
- “Are there support groups or resources available for families affected by microtia?”
For Out-of-Town Families
Traveling to Beverly Hills, Los Angeles for Care
Families travel to Beverly Hills from across the country and around the world for microtia care. Here’s what to know before your visit.
Building Access
Second floor, Suite 200. Elevator access available in the lobby.
Parking
On-site parking garage beneath the building. Street metered parking on Wilshire Blvd.
From LAX
Approximately 30 minutes via 405 N to Santa Monica Blvd.
Accommodations
We offer complimentary airport transportation and assistance with local accommodations for surgical patients.
Nearby
Contact Dr. Tahiri
Get in Touch
Choosing a surgeon for you or your child is one of the biggest decisions you’ll ever make. You want someone with the right training, the right experience, and the right approach.
Dr. Tahiri checks all those boxes. But more than that, he understands what this journey means for your family. He knows that behind every medical case is a child with dreams and parents who want the very best for them.
You don’t have to figure this out alone. We’re here to help, and we’re ready when you are.
Call the Office (310) 255-4476“Amazing experience with Dr Tahiri and his team. Everyone made us feel so comfortable and safe and eased all my fears of having my 5 year old go through surgery… “
Contact Dr. Tahiri today by filling out the form above or calling the office at (310) 255-4476. For families outside the Los Angeles area: We’re happy to start with a virtual consultation to discuss you or your child’s condition and determine if an in-person visit makes sense.
Dr. Tahiri accepts most PPO insurance plans. Our team will guide you through every step of the process, from initial consultation to complete recovery.